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Detection of Enteroviral RNA in Myocardial/Valvular Tissue by Fluorescent in situ Hybridization in Acute Mitral Regurgitation due to Ruptured Chordae Tendineae:A case report Tsutomu Saji 1 , Masami Segawa 1 , Masahiko Hachiya 1 , Osamu Motoyama 1 , Yasufumi Ozawa 1 , Yu Aoki 1 , Norio Matsuo 1 , Yoshinori Takanashi 1 , Naoto Suzuki 2 , Kaneyoshi Miwa 3 , Yukumasa Kazuyama 4 11st Department of Pediatrics, School of Medicine, Toho University 2Thoracic & Cardiovascular Surgery, School of Medicine, Toho University 3Department of Legal Medicine, School of Medicine, Toho University 4Research & Development Center of Hygienic Science, School of Medicine, Kitasato University Keyword: 僧帽弁腱索断裂 , 心筋炎 , エンテロウイルス , myocarditis , enterovirus , rupture of chordae tendineae pp.87-91
Published Date 1995/1/15
DOI https://doi.org/10.11477/mf.1404900994
  • Abstract
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A 10-month-old boy was admitted to our emergency room with complaints of progressive dyspnea and cyanosis. He was completely healthy until 2 days before admission when he began to suffer a slight fever and frequent diarrhea. On physical examination there was a grade 3/6 holosystolic murmur at the apex and left axilla. Bacterial culture and virus isolation were negative. Laboratory findings included the following: WBC 18,900/μ1, CRP 3.6mg/d1. GOT 61 IU/ l. LDH 1.126 IU/l. CK 376 IU/l, CK-MB 37 ILI/ l. Chest X-ray demonstrated evidence of severe pulmonary edema and normal cardiac silhouette with a cardiothoracic rate of 47%. 2-D echocardiography revealed severe mitral regurgitation due to rupture of the chordae tendineae (CT) of the posterior mitral valve (MV) leaflet. Despite intensive therapy for respiratory failure and cardiac dysfunction, the patient's condition rapidly deteriorat-ed. The patient then underwent reconstruction of the ruptured CT and valvuloplasty on the 3rd hospital day. Operative findings revealed that three CT attached to the posterior leaflet of the MV were completely reputur-ed. Microscopic findings revealed a small focus of infiltration of inflammatory cells and myxomatous degeneration in MV. However, severe mitral regurgita-tion and the state of low cardiac output occured againafter surgery. Replacement of the reconstructed CT and MV with ♯19 St. Jude Medical prosthesis was undertaken. Postoperative cardiac function was insufficient, and the patient expired 7 days after surgery. Autopsy findings demonstrated intercellular edema and inflammatory cell infiltration in the myocardium of the right ventricle (RV) and the left ventricle (LV). Fluo-rescent in situ hybridization (FISH) for detection of enteroviral genome was performed in cardiac samples using a biotin-tailed DNA probe produced by RT-PCR from 154bp of the non-coding region of coxsackie virus type B1 cDNA, which is specific for a variety of entero-viruses (EV). As a result, positive hybridization signals for EV RNA were clearly observed in several samples obtained from the LV through the left atrium (LA) including the mitral valve leaflet. papillary muscle, CT, the junction of the LA and the LV. RV free wall, LV free wall, and the endocardial cushion including the upper part of the interventricular septum.

We conclude that rupture of CT of the MV may occur in EV myocarditis. In this patient. FISH technique was useful for detection of virus genome in the myocardium and valvular apparatus. Molecular study should be performed in patients with sudden onset of ruptured CT of the MV with unexplained etiology.


Copyright © 1995, Igaku-Shoin Ltd. All rights reserved.

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